More in state must shop for health care coverage

Gov.
Scott Walker rejected federal money to expand the state's Medicaid
program because he would like more people to get coverage through
commercial health plans instead of government programs.

But the decision also means that
tens of thousands more people will need to shop for a commercial health
plan on the new marketplace known as an exchange.

That,
in turn, will put additional demands on people at hospitals, community
health centers and community groups who are expected to do much of the
work in helping people sign up for coverage.

"We unfortunately are going to
see a very different marketplace in Wisconsin than we have the
opportunity to create," said Sara Eskrich, a health care policy analyst
at the Wisconsin Council on Children and Families, an advocacy group.
"And we are going to have to work with that."

One advantage of Walker's plan
is that health insurance sold on the exchange will pay higher rates to
doctors and hospitals and generally provide better access to care.

At
the same time, people who get subsidized coverage through the exchange
will have to pay a premium of as much as 3% of their income and will
have higher deductibles than with BadgerCare Plus, the state's Medicaid
program for families with children under 19.

They also are going to have to
sign up for coverage, a process that will entail shopping for a health
plan and determining the federal subsidies available to make the
coverage more affordable.

Karla
Ashenhurst, director of system advocacy and public policy for Ministry
Health Care and Columbia St. Mary's Health System, said that conceivably
fewer people in Wisconsin could have health insurance coverage a year
from now, although both health systems plan to help people enroll.

The governor's proposal will
cost the state almost $150 million more in the next two years — and
potentially more than $450 million through 2021 — than if the state had
accepted the federal money available under the Affordable Care Act,
according to estimates by the Legislative Fiscal Bureau.

That includes $30 million in
state dollars for the $73.5 million added to the proposed state budget
by the legislative budget committee to compensate hospitals for an
expected increase in people without health insurance under the
governor's proposal.

The governor's proposal means
that an estimated 80,000 to 90,000 people who would have gotten coverage
through Medicaid will need to buy subsidized health insurance through
the exchange.

Some now have coverage through BadgerCare Plus. Others previously hadn't been eligible for coverage.

The Legislative Fiscal Bureau as
well as critics of the governor's proposal said that many people who
would have been eligible for coverage under Medicaid will not shop for
private plans.

"We know that not everyone is going to make that transition," Eskrich said.